Retail and Urgent Care Articles
More patients are having operative repair for displaced midshaft clavicle fractures. This meta-analysis of 6 RCTs found that the rate of nonunion was markedly reduced and final functional outcome was also improved (though not as strikingly) with operative management.
Noninvasive measurement of ejection fraction with an iPhone app is possible and very accurate. When this becomes publicly available, it will be a game changer.
In a largely adult population, those presenting to the ED with diarrhea only and no vomiting had C. difficile colitis as the cause in 10%, and almost 40% lacked risk factors.
Not only is coffee not bad for you, it could save your life! This study of over half a million people in 10 European countries found coffee consumption was associated with decreased overall mortality in men and women.
Allowing parents the option to wait and see if their child did not improve or worsened in 48 hours after the diagnosis of acute otitis media in the ED vs. filling the prescription right away resulted in a dramatic reduction in antibiotic use with little downside in this RCT.
Learn the ECG patterns for posterior MI, left main disease, the ominous isolated T-wave inversion in aVL, large upright T-wave in V1, and Wellen's warning. This full text article is mandatory reading.
History and exam features are not useless in the evaluation of patients with chest pain, but they must be used as part of a risk stratification strategy that includes ECG and troponin.
The PERC rule is a powerful diagnostic tool. If you determine a patient has low clinical gestalt for PE and all 8 PERC criteria are negative, then PE has been ruled out without checking a D-dimer or CT.
A 5 sentence letter to the NEJM editor in 1980 has been cited over 600 times to support opiate prescribing, which was not even the point of the original letter. We bought the line that opiates for legitimate pain were not addictive and didn't consider the source.
Adverse effects from antibiotics are very common, up to 20% of the time in hospitalized patients. Only use them when needed.
Use a score like CURB-65 (or CRB-65 if you don't have labs) when making clinical decisions about the disposition of patients with community acquired pneumonia.
Managing interruptions by delaying or rejecting the interruption may improve safety when they occur during critical tasks.
You need to know this decision rule cold. Before doing a head CT on any child, think through this decision aid first
It makes sense to treat an allergic reaction with an antihistamine. This study suggests that treating patients with an allergic reaction with a H1-antagonist may decrease the chance of disease progression to anaphylaxis, though the level of evidence is weak.
This simplified protocol worked well, was safe, and provided a one-size-fits-all approach to the workup of VTE. It also reduced CT use by 14%.
For uncomplicated cellulitis in otherwise healthy patients, cephalexin alone is probably adequate.
Loperamide abuse is increasingly seen. It can be rarely associated with cardiac conduction system disturbances. Talk to poison control, and put these patients on a monitor.
The Ottawa SAH Rule is helpful in deciding which patients need further workup in the ED, but make sure your patient is similar to those included in the validation study.
Prednisone 40mg daily x 4 days was not helpful in reducing itching in patients with simple urticaria.
This study found 1% tetracaine for 24 hours appeared to be safe for treating corneal abrasion pain.
These 4 predictors are somewhat helpful in distinguishing transient synovitis of the hip from septic arthritis. Note the limitations of the Kocher Criteria when using it in practice, and err on the side of orthopedic consultation and/or admission.
Dexamethasone is beneficial for mild croup, not just moderate to severe.
Statewide, non-specific mandates may help a little. Local and departmental policy change, with provider buy in, is even better.
Older patients taking antiplatelet agents, including aspirin 81mg, or anticoagulants have tSAH about 3.5% of the time with simple ground level fall.
If you need to know the child's weight, just ask the parent. It was the most accurate weight estimate in this prospective comparison study.
Spinal manipulative therapy is a part of the armamentarium for acute low back pain treatment.
ED opioid policies can make a big impact on prescribing patterns in a group of providers and help curb the current epidemic of opiate abuse.
Cancer as a young person increases subsequent risk for cerebrovascular events. Cancer is in itself a risk factor for stroke.
This study says that more patients may feel better with a dose of dexamethasone for sore throat.
There was an association with short-term steroid use and several adverse outcomes.